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ADVANCES IN ELECTROCARDIOGRAMS – METHODS AND ANALYSIS

ELECTROCARDIOGRAMS
Edited by Richard M. Millis .
402 pages . 

The human heart has a long evolutionary history. Recent developments in genetic 
analysis suggest that the roots of some heart diseases stem from the hearts of our 
invertebrate and vertebrate ancestors. Whether squids, butterflies, grasshoppers or 
tarantulas possess predispositions for heart disease and death from heart failure in 
their natural environments is unknown. However, at least some of the events
occurring during embryonic organogenesis of the human heart appear to reflect the 
evolutionary, and phylogenetic structural adaptations that may increase susceptibility 
to the cardiac diseases found in humans. The basic structure and function of the 
vertebrate heart as a blood pump, derives from cardiac myocytes which are electrically 
coupled by gap junctions. Tight coupling and compact arrangement of the cardiac 
myocytes are characteristic of the human heart. However, a looser coupling and 
architecture was observed in the hearts of invertebrate and lower vertebrate animals.
The loose arrangement characteristic of the human ancestral heart is adapted to a heart 
that functions to pump hemolymph to the tissues by a, more or less, peristaltic 
movement similar to that seen in the gastrointestinal tract. Such peristaltic pumping is 
adequate for animals possessing hearts which consist of a primitive conduit, for 
insuring continuous flow of nutrients to tissues under relatively constant conditions 
and demands. On the other hand, the hearts of mammals are designed to maintain a 
continuous flow of nutrients to tissues under more variable conditions than those of 
invertebrates and lower vertebrates, thereby requiring responsiveness to complex 
stimuli such as those associated with changes in metabolic, emotional, immunological 
and many other physiological functions.
Embryonic development of the gap junctions which give rise to tight electrical 
coupling in the human heart appear to partly depend on the production of a proline 
rich repeat unit structure of a protein named Xin, derived from the Chinese word for 
heart, center or core. Xin proteins are known to bind to various actin, cadherin and 
catenin proteins which organize into zona adherens of gap junctions. When the Xin 
proteins, together with others involved in the gap junction morphology, are deficient 
in mutant zebrafish, lethal cardiomyopathies and heart failures occur. When the Xin 
proteins are deficient in knockout mice, there is an absence of the compactness and
tight electrical coupling characteristic of the mammalian heart, resulting in 
morphologies more or less like fish hearts, which results in cardiomyopathies and 
heart failures similar to those observed in humans with lethal neonatal 
cardiomyopathies. Some neonatal cardiomyopathies appear to result from genetic 
defects in proteins associated with structuring the gap junctions for electrical coupling 
between neonatal cardiac myocytes. In addition to the aforementioned genetic 
abnormalities of gap junctions, epigenetic mechanisms which affect the electrical 
coupling, and signaling mechanisms of cardiac myocytes have been implicated in 
adaptive and maladaptive hypertrophy, remodeling and various morphological 
abnormalities of the heart. Such epigenetic modifications may explain congenital and 
acquired susceptibilities to cardiomyopathies and heart failures throughout a person’s 
life.
Cardiac signaling has evolved based on endogenous myogenic pacemaker mechanisms 
for excitation and recovery by phases of depolarization and repolarization, and on 
exogenous visceral motor (autonomic) nerve directed mechanisms utilizing 
neurotransmitter release to regulate the phases of depolarization and repolarization. 
Invertebrate and lower vertebrate hearts, with loose electrical coupling by gap 
junctions, depend on the development of a pacemaker with higher rates of 
depolarization in the receiving areas to drive, via loose connectivity and electrical 
coupling, the pumping areas. These primitive hearts have thin layers of cardiac 
myocytes, not well organized into chambers. It seems that heart chambers with 
distinct layers of endothelium, and myocardium have evolved in parallel with more 
complex structures of Xin and other proteins organized as intercalated discs. These 
findings suggest that electrical coupling of cardiac myocytes has a large impact on 
determining heart morphology and, therefore, physiology.
In this volume, Advances in Electrocardiograms - Methods and Analysis, the reader will 
revisit some classical concepts and will be introduced to a number of novel, innovative 
methods for recording and analyzing the human electrocardiogram. Being mindful of 
the important role of cardiac electricity in determining heart structure and function 
will, no doubt, lead the reader to a greater appreciation of the electrocardiogram in 
health and disease.

Richard M. Millis, PhD
Editor
Dept. of Physiology & Biophysics
The Howard University College of Medicine
USA

CONTENTS :

Part 1 Cardiac Structure and Function 1


Chapter 1 Cardiac Anatomy 3
Augusta Pelosi and Jack Rubinstein

Part 2 ECG Technique 21


Chapter 2 Low-Frequency Response and the Skin-Electrode 
Interface in Dry-Electrode Electrocardiography 23
Cédric Assambo and Martin J. Burke

Chapter 3 Implantation Techniques of Leads for Left 
Ventricular Pacing in Cardiac Resynchronization Therapy and Electrocardiographic Consequences of the Stimulation Site 53
Michael Scheffer and Berry M. van Gelder

Chapter 4 Non Contact Heart Monitoring 81
Lorenzo Scalise

Chapter 5 Automated Selection of Optimal ECG Lead Using 
Heart Instantaneous Frequency During Sleep 107
Yeon-Sik Noh, Ja-Woong Yoon and Hyung-Ro Yoon

Part 3 ECG Feature Analysis 125


Chapter 6 A Novel Technique for ECG Morphology 
Interpretation and Arrhythmia Detection Based on Time Series Signal Extracted from Scanned ECG Record 127
Srinivasan Jayaraman, Prashanth Swamy, Vani Damodaran and N. Venkatesh

Chapter 7 QT Interval and QT Variability 141
Bojan Vrtovec and Gregor Poglajen

Chapter 8 The Electrocardiogram – Waves and Intervals 149
James E. Skinner, Daniel N. Weiss and Edward F. Lundy

Chapter 9 Quantification of Ventricular Repolarization 
Dispersion Using Digital Processing of the Surface ECG 181
Ana Cecilia Vinzio Maggio, María Paula Bonomini, Eric Laciar Leber and Pedro David Arini

Chapter 10 Medicines and QT Prolongation 207
Ryuji Kato, Yoshio Ijiri and Kazuhiko Tanaka

Chapter 11 Concealed Conduction 217
Hasan Ari and Kübra Doğanay

Chapter 12 Recognition of Cardiac Arrhythmia by Means 
of Beat Clustering on ECG-Holter Recordings 225
J.L. Rodríguez-Sotelo, G. Castellanos-Domínguez and C.D. Acosta-Medina

Part 4 Heart Rate Variability 251

Chapter 13 Electrocardiographic Analysis of 
Heart Rate Variability in Aging Heart 253
Elpidio Santillo, Monica Migale, Luca Fallavollita, Luciano Marini and Fabrizio Balestrini

Chapter 14 Changes of Sympathovagal Balance Measured 
by Heart Rate Variability in Gastroparetic Patients Treated with Gastric Electrical Stimulation 271
Zhiyue Lin and Richard W. McCallum

Chapter 15 Associations of Metabolic Variables with Electrocardiographic Measures of Sympathovagal Balance in Healthy Young Adults 283
Richard M. Millis, Mark D. Hatcher, Rachel E. Austin, Vernon Bond and Kim L. Goring

Part 5 ECG Signal Processing 295


Chapter 16 An Analogue Front-End System with a 
Low-Power On-Chip Filter and ADC for Portable ECG Detection Devices 297
Shuenn-Yuh Lee, Jia-Hua Hong, Jin-Ching Lee and Qiang Fang

Chapter 17 Electrocardiogram in an MRI Environment: 
Clinical Needs, Practical Considerations, Safety Implications, Technical Solutions and Future Directions 309
Thoralf Niendorf, Lukas Winter and Tobias Frauenrath

Chapter 18 Customized Heart Check System by Using 
Integrated Information of Electrocardiogram and Plethysmogram Outside the Driver’s
Awareness from an Automobile Steering Wheel 325
Motohisa Osaka

Chapter 19 Independent Component 
Analysis in ECG Signal Processing 349
Jarno M.A. Tanskanen and Jari J. Viik

Part 6 ECG Data Management 373


Chapter 20 Broadening the Exchange of Electrocardiogram 
Data from Intra-Hospital to Inter-Hospital 375
Shizhong Yuan, Daming Wei and Weimin Xu .


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